Healthcare Provider Details

I. General information

NPI: 1457663569
Provider Name (Legal Business Name): MALGORZATA ANNA CIOMEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 E PALATINE RD
PALATINE IL
60074-5493
US

IV. Provider business mailing address

756 E PALATINE RD
PALATINE IL
60074-5493
US

V. Phone/Fax

Practice location:
  • Phone: 847-909-7830
  • Fax:
Mailing address:
  • Phone: 847-909-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.009596
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: